Vinci System Research Articles

Robotic-assisted single incision myomectomy in large myoma cases

Laparo-endoscopic single-incision surgery (LESS) has been developed and gradually adopted for both benign and malignant gynecological procedures. However, LESS has been hindered for use in procedures like myomectomy by limitations in natural architecture and instrumentation, especially in suturing. The da Vinci system features a single-site platform and wristed needle driver, which may help overcome conventional LESS limitations. This case report study describes the feasibility of this robotic single-site (RSS) platform in large myoma cases and offers suggestions. Two cases of myomectomy with large myomas (with maximum diameters of 160 and 120 mm) with different locations, were addressed by RSS. Operative time was 180 and 240 minutes. Estimated blood loss was 200 and 150 ml. Pathologic analysis revealed uterine leiomyomas of 910 and 870 grams. No serious peri- or post-operative complications occurred. Myomectomy with large myoma has presented a surgical challenge. RSS myomectomy appears to be a safe and feasible technique for it regardless of its localization. Advantages include less postoperative pain, fast recovery, less impact on quality of life, and improved cosmesis. LESS surgery has been challenging concerning suturing and multi-laparoscopic or multi-port robotic myomectomy can be difficult to extract myoma, especially with morcellation. RSS could be a solution that enables ease of manipflation and extraction.

Laparoscopic vs. robotic colorectal resections: new insights from the American College of Surgeons National Surgical Quality Improvement Program

We read with interest the article by Feinberg et al. (1) reporting the short-term results for colorectal resections performed by laparoscopy or Da Vinci System ® .

Greatness in failure: a look at Leonardo da Vinci and his drawings of the heart

Greatness in failure: a look at Leonardo da Vinci and his drawings of the heart

Robotic Surgery: A Solution in Search of a Problem-A Bayesian Analysis of 343 Robotic Procedures Performed by a Single Surgical Team.

Despite the obvious technical advantages, the value of robotic surgery is highly debated and its cost-effectiveness has been questioned. The aim of this article is to provide an evaluation of the outcomes of robotic surgery in comparison to conventional laparoscopy. A decision analysis based on the Bayes' theorem and the decision tree was used. The robotic approach was compared with the laparoscopic approach for each of the pathologies discussed in this study. The data on robotic surgeries were obtained from a retrospective study conducted between January 2008, when the da Vinci system became available in our institution, and December 2014. During this period, 343 consecutive robotic operations were performed by a single surgical team. There were statistically significant differences in the likelihood of an optimal patient outcome when the robotic approach was used for hysterectomies to remove malignant tumors, difficult splenectomies, gastrectomies, and rectal resections. The results did not show important differences between the two techniques for easy splenectomies and hysterectomies for benign cases. The results of our study confirm the value of robotic surgery, as an alternative and complex surgical tool, for hysterectomies to remove malignant tumors, difficult splenectomies, gastrectomies, and rectal resections. Laparoscopy was preferred for easy splenectomies and hysterectomies for benign cases, because of the lack of improved outcome with robotic surgery and the high cost of robotic surgery.

Infant Robotic Cleft Palate Surgery: A Feasibility Assessment Using a Realistic Cleft Palate Simulator.

A surgical robot offers enhanced precision, visualization, and access and the potential to improve outcomes in cleft palate surgery. The goal of this study was to investigate the feasibility of using the da Vinci robot for cleft palate repair in infants using a cleft palate simulator test bed. A high-fidelity cleft palate simulator was developed that allows performance of a robotic cleft palate repair procedure. A complete cleft palate repair was performed with the da Vinci Si with 5-mm instruments and the da Vinci Xi with 8-mm instruments. The advantages of the robotic approach were assessed in comparison with using standard instruments. For each system, arm repositioning, collisions, instrument and endoscope excursion, wrist orientation, and vision were compared for 12 steps of the repair. The cleft palate simulator provided a reproducible platform for testing robotic cleft palate surgery. The advantages of the robotic approach were the ability to articulate a miniature wrist intraorally with superior visualization, increased ambidexterity, and improved ergonomics compared with using standard instruments. Cleft palate repair with the Xi was superior to the Si with respect to arm repositioning, instrument collisions and excursion, and wrist orientation. However, Xi performance remained suboptimal because of the larger instruments. Robotic cleft palate repair using the da Vinci system offers advantages compared with the traditional approach. Cleft palate repair is more feasible with the Xi and 8-mm instruments. However, performance is limited by the instrumentation, which requires modification to ensure safety and efficacy. Therapeutic, V.

Robotic resections in hepatobiliary oncology - initial experience with Xi da Vinci system in India.

Minimal invasive surgery has proven its advantages over open surgeries in the perioperative period. Food and Drug Administration approved da Vinci robot in 2000. The latest version, da Vinci Xi system has a mobile tower-based robot with several modifications to improve the functionality, versatility, and operative ease. None of the centers have reported exclusively on hepatobiliary oncology using the da Vinci Xi system. We report our initial experience. To study the feasibility, advantages, and discuss the operative technique of da Vinci Xi system in hepatobiliary oncology. Data were analyzed retrospectively from a prospectively maintained database from June 2015 to October 2016. Twenty-five patients with suspected or proven hepatobiliary malignancies were operated. Total robotic technique using da Vinci Xi system was used. Demographic details and perioperative outcomes were noted. Of the 25 surgeries, 14 patients had a suspected gallbladder malignancy, 11 patients had primary or metastatic liver tumor. Median age was 53 years. The average duration of surgery was 225 min with a median blood loss 150 ml. The median postoperative stay was 4 days. The median nodal yield for radical cholecystectomy was seven. Five patients required conversion. Two of these developed postoperative morbidity. Robotic surgery for hepatobiliary oncology is feasible and can be performed safely in experienced hands. Increasing experience in this field may equal or even prove advantageous over conventional or laparoscopic approach in future. A cautious approach with judicious patient selection is the key to establishing robotic surgery as a standard surgical approach.

Clinical outcomes of robotic mitral valve repair: a single-center experience in Korea.

Since the inception of robotic mitral valve repair (MV) in 2007 at our institution, it has become an acceptable surgical option with proven efficacy and safety. The objective of this study is to analyze the early and long-term clinical outcomes of patients undergoing robotic MV repair. A total of 310 patients (aged 48.4±13.7 years, 201 males) undergoing robotic MV repair using the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA) between August 2007 and December 2015 in our institution were evaluated. The preoperative demographics, operative profiles and postoperative outcomes including follow-up echocardiographic results were analyzed. Successful MV repair was achieved in 98.4% (n=305) of patients, with no significant residual mitral regurgitation (MR) postoperatively. There were no early postoperative deaths. Early postoperative complications included: stroke (n=3, 1.0%), new onset dialysis (n=1, 0.3%) and reoperation (n=3, 1.0%). During a median follow-up of 55.7 months (inter-quartile range 30.3 to 81.3 months), six (1.9%) patients died, while four patients underwent late reoperation for mitral regurgitation (n=2) or infective endocarditis (n=2). Major event-free survival at five years was 87.6%. Late echocardiographic profiles (>6 months) were obtained in 295 (95.2%) patients. During follow-up, 32 (10.8%) patients developed significant mitral regurgitation (MR > grade 2), while freedom from significant MR at five years was 86.5%. Robotic MV repair is a safe procedure with acceptable postoperative results, including low early postoperative morbidity and mortality and acceptable long-term repair durability.

A Four-DOF Laparo-Endoscopic Single Site Platform for Rapidly-Developing Next-Generation Surgical Robotics

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures, but have notable shortcomings, including limited instrument motion and reduced dexterity. Endoscopic robots, like the intuitive surgical da Vinci system, have become an effective tool for many types of surgeries; however, these tools still have fundamental limitations with manipulator access, which reduces their effectiveness for many surgical procedures, like colectomy, cholecystectomy, and gynecologic oncology. Laparo-endoscopic single-site (LESS) robots operate in vivo, and overcome many of these limitations. Here, a four-degrees of freedom (DOF) surgical robot is presented as a tool to enable refinement of the LESS platform as a surgical tool, while also looking forward to applications in telesurgery and haptic feedback.

Robotic lobectomy: an essential addition to the minimally invasive armory

As the only robotic system approved by the United States Food and Drug Administration for lung surgery, the Da Vinci System (Intuitive Surgical, Sunnyvale, CA, USA) is gaining popularity worldwide as an important alternative to the conventional minimally invasive surgical approach of video-assisted thoracic surgery (VATS). The robotic system is considered a significant evolution in the development of surgical tools, allowing the surgeon to view the surgical site in three dimensions and perform the operation via a console located near the operating table. The endo-wrist instruments attached to the robotic arms provide a wide range of precision movements with greater dexterity. Moreover, the hand tremor of the surgeon can be filtered out by using a 6-Hz motion filter, which guarantees precise micro-movement around vital structures.

Neurophysiological measures for users' training objective assessment during simulated robot-assisted laparoscopic surgery.

Minimally invasive surgery can be performed with robotic assistance, as evolution of laparoscopic surgery. Robots for assisted surgery are far from being user friendly and require extensive training. To this end, ad-hoc devices and experimental set-ups are needed. The da Vinci system is one of the most diffused surgical robotics technology. The aim of the study was two-fold: i) to propose a neurophysiological measure by which objectively assess the learning progress of the users by means of a simulator of the da Vinci system, and ii) to demonstrate the advantages of cognitive assessment with respect to the standard methodologies for the evaluation of training efficiency.

Focused ultrasound and metrics of diffusion of disruptive medical innovation

Innovation, as a concept in healthcare, has broad implications ranging from diagnosis to treatment of disease. The advent of new surgical modalities and medical devices continues to refine and reshape...

Robotic Rectal Cancer Surgery

The oncological outcome of patients with rectal cancer has improved considerably over the past few decades. This is mainly due to the introduction of the surgical concept of total mesorectal excision (TME) and the implementation of multimodal treatment strategies. Additionally, it has recently been demonstrated that the oncological results of open and laparoscopic TME are comparable. For some time there has been an ongoing debate on the potential relevance of robotic assistance systems in visceral surgery. The aim of this study was to evaluate the operative and perioperative outcomes of patients with rectal or rectosigmoid cancer, who were operated on using the Da Vinci Surgical System. We retrospectively analysed the outcomes of 202 consecutive patients, who were operated between September 2010 and November 2015 in three Surgical Centers. The cohort consisted of 136 men and 66 women with a mean BMI of 28. We performed the following procedures: 49 anterior rectal resections, 119 low anterior rectal resections, and 34 abdominoperineal excisions. Conversion to an open procedure was required in 13 patients. Non-surgical complications (n = 27) occurred in 24 patients (12%) and surgical complications (n = 67) in 62 patients (31%). Most complications were due to abdominal or sacral wound infections (n = 25) and anastomotic leaks (n = 18). The mortality rate within 30 days was 2%. The rate of R0 resections was 95%, with circumferential resection margins being negative in 98% of the patients. The quality of the mesorectal resection was scored as good in 91% of the patients. The Da Vinci Surgical System can be used safely and with a low complication rate for surgical treatment of rectal cancer. While primary evidence suggests that the outcome of robotic-assisted surgery is comparable with open and laparoscopic surgery, its definitive value has to be determined upon publication of the prospective randomized ROLARR trial. The main advantages of the Da Vinci system are its endowristed instruments with multiple degrees of freedom and its optimised visualisation (3D, stable camera platform controlled by the surgeon). Another positive feature is the significant ergonomic advantage for the surgeon.

Robot assisted Aortic and Non-aortic Vascular Operations

The aim of this study was to evaluate the clinical experience with 310 robot assisted vascular procedures. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon. From November 2005 to May 2014, 310 robot assisted vascular operations were performed. Two hundred and twenty four patients were prospectively evaluated for occlusive disease, 61 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, four for a splenic artery aneurysm, one for a internal mammary artery aneurysm, and after the unsuccessful endovascular treatment five for hybrid procedures, two patients for median arcuate ligament release and nine for endoleak II treatment post EVAR. Among these patients, 224 underwent robotic occlusive disease treatment (Group I), 65 robotic aorto-iliac aneurysm surgery (Group II) and 21 other robotic procedures (Group III). A total of 298 cases (96.1%) were successfully completed robotically. In 10 patients (3.2%) conversion was necessary. The 30 day mortality was 0.3%, and two (0.6%) late prosthetic infections were seen. Targeted Group I and Group II patients were compared. Robotic ilio-femoral bypass, aorto-femoral bypass, or aorto-iliac thrombo-endarterectomy with prosthetic patch (Group I) required an operative time of 194 (range, 127-315) minutes and robotic aorto-iliac aneurysm surgery (Group II), 253 (range, 185-360) minutes. The mean aortic cross clamping time was 37 minutes in Group I and 93 minutes in Group II. The mean blood loss was more significant in Group II (1,210mL) than in Group I (320mL). From a practical point of view, the greatest advantage of the robot assisted procedure has been the speed and relative simplicity of construction of the vascular anastomosis. This experience with robot assisted laparoscopic surgery has demonstrated the feasibility of this technique in different areas of vascular surgery.

An all-joint-control master device for single-port laparoscopic surgery robots.

Robots for single-port laparoscopic surgery (SPLS) typically have all of their joints located inside abdomen during surgery, whereas with the da Vinci system, only the tip part of the robot arm is inserted and manipulated. A typical master device that controls only the tip with six degrees of freedom (DOFs) is not suitable for use with SPLS robots because of safety concerns. We designed an ergonomic six-DOF master device that can control all of the joints of an SPLS robot. We matched each joint of the master, the slave, and the human arm to decouple all-joint motions of the slave robot. Counterbalance masses were used to reduce operator fatigue. Mapping factors were determined based on kinematic analysis and were used to achieve all-joint control with minimal error at the tip of the slave robot. The proposed master device has two noteworthy features: efficient joint matching to the human arm to decouple each joint motion of the slave robot and accurate mapping factors, which can minimize the trajectory error of the tips between the master and the slave. We confirmed that the operator can manipulate the slave robot intuitively with the master device and that both tips have similar trajectories with minimal error.

Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes.

Sexual and urinary dysfunctions are complications in radical treatment of deep infiltrating endometriosis (DIE) with colorectal involvement. The aim of this article is to report the preliminary results of our single-institution experience with robotic treatment of DIE, evaluating intraoperative and postoperative surgical outcomes and focusing on the impact of this surgical approach on autonomic functions such as urogenital preservation and sexual well-being. From January 2011 through December 2013, a case series of 10 patients underwent robotic radical treatment of DIE with colorectal resection using the da Vinci System. Surgical data were evaluated, together with perioperative urinary and sexual function as assessed by means of self-administered validated questionnaires. None of the patients reported significant postoperative complications. Questionnaires concerning sexual well-being, urinary function, and impact of symptoms on quality of life demonstrated a slight worsening of all parameters 1 month after surgery, while data were comparable to the preoperative period 1 year after surgery. Dyspareunia was the only exception, as it was significantly improved 12 months after surgery. Robot-assisted surgery seems to be advantageous in highly complicated procedures where extensive dissection and proper anatomy re-establishment is required, as in DIE with colorectal involvement. Our preliminary results show that robot-assisted surgery could be associated with a low risk of complications and provide good preservation of urinary function and sexual well-being.

Robotic surgery in colorectal cancer: present and future

After more than a decade of development, the role of robotic rectal cancer surgery has been established. However robotic right hemicolectomy has just commenced. For rectal cancer surgery, the Da Vinci system is more flexible, accurate, and stable than traditional laparoscopy. The robotic surgery is safe and efficient, and protects the pelvic autonomic nerve function better. At the same time, robotic surgery is easy to learn, promoting its popularization. In robotic right hemicolectomy, the surgery suitable for Da Vinci system is also improved. Da Vinci system is not perfect. High cost is a major obstacle to the wide applications. Lack of tactile feedback and limited mobility of robotic arms also should not be ignored. The next generation of robotic system may make up for these deficiencies through a number of new technologies. The combination of robotics with single port laparoscopic techniques and multi-organ resections is expected to expand the advantages of robotic surgery in colorectal cancer and promote its development.

Robotic-Assisted Hiatal Hernia Surgery with the Da Vinci System: A 2-Year Experience in a Single Institution

Abstract Studies reporting on the recurrence rate after laparoscopic repair of large hiatal hernias (HH), including anatomical asymptomatic recurrence, are scarce. So far, the impact of telematic surgical approach in Gastroesophageal Reflux Disease (GERD) is still obscure. In this prospective study, we analyzed the da Vinci Intuitive Surgical robotic system for antireflux surgery. In August 2012, we set up a pilot study to evaluate the efficacy of laparoscopic telerobotic surgery using the three-arm da Vinci system. Optimal trocar positions, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity, as well as mortality rate, were analyzed.

System design and animal experiment study of a novel minimally invasive surgical robot.

Robot-assisted minimally invasive surgery has shown tremendous advances over the traditional technique. However, currently commercialized systems are large and complicated, which vastly raises the system cost and operation room requirements. A MIS robot named 'MicroHand' was developed over the past few years. The basic principle and the key technologies are analyzed in this paper. Comparison between the proposed robot and the da Vinci system is also presented. Finally, animal experiments were carried out to test the performance of MicroHand. Fifteen animal experiments were carried out from July 2013 to December 2013. All animal experiments were finished successfully. The proposed design method is an effective way to resolve the drawbacks of previous generations of the da Vinci surgical system. The animal experiment results confirmed the feasibility of the design.

PD18-11 A LAPAROSCOPIC COMBINATION WITH COMPARABLE ERGONOMIC RESULTS TO ROBOTIC SURGERY, TESTED IN AN EXPERIMENTAL LAPAROSCOPIC RADICAL PROSTATECTOMY SETTING

PD18-11 A LAPAROSCOPIC COMBINATION WITH COMPARABLE ERGONOMIC RESULTS TO ROBOTIC SURGERY, TESTED IN AN EXPERIMENTAL LAPAROSCOPIC RADICAL PROSTATECTOMY SETTING

The Minimally Invasive Manipulator: An ergonomic and economic non-robotic alternative for endoscopy?

Introduction: Since the da Vinci robotic system was introduced, it has been reported to have ergonomic advantages over conventional laparoscopy (COV). High investments associated with this system challenged us to design a more economical, mechanical alternative for improvement of laparoscopic ergonomics: the Minimally Invasive Manipulator (MIM). Material and methods: An earlier reported MIM prototype was investigated. Its shortcomings were input for the establishment of design criteria for a new prototype. Results: A new prototype was developed, aiming at improved intuitiveness and ergonomics. The handle and instrument tip were redesigned and the parallelogram mechanism was converted from linear moving parts to mainly rotating parts. Discussion: The new prototype was tested by a panel of experts and novices during an indicative ergonomic experiment. A major advantage of the MIM seems to be the possibility to perform laparoscopic surgery in a sitting position, in line with the working axis, instead of standing at the side of the patient. At an estimated cost level of 10% of the da Vinci system, the MIM can be an economical alternative for the enhancement of laparoscopy ergonomics. However, further development for clinical feasibility is necessary.